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目的比较新型主动脉旁反搏装置(paraaortic counterpulsation device,PACD)与主动脉内球囊反搏(intraaortic balloon pump,IABP)装置对羊重度急性心力衰竭的辅助效果。方法选成年小尾寒羊8只,将自制PACD(每搏量为55 ml)的无瓣人工血管吻合于降主动脉,同时于降主动脉内植入IABP(每搏量为40 ml)进行反搏辅助。结扎冠状动脉分支建立重度急性心力衰竭动物模型,观察PACD和IABP辅助对重度急性心力衰竭辅助后的血流动力学变化;实验结束后观察PACD辅助和羊主要器官的变化。结果成功建立了8只羊心力衰竭模型,心力衰竭后心排血量(CO)、肺毛细血管楔压(PCWP)、平均动脉压(MAP)和左心室舒张期末压(LVEDP)与基础值比较差异均有统计学意义(t=-8.466,34.083,25.767,-5.219,P=0.000)。应用IABP和PACD辅助后,平均动脉舒张压(MADP)较辅助前不明显或明显增高(38.34±7.13 mm Hg vs.38.42±6.81 mm Hg,P=0.418;38.34±7.13 mmHg vs.54.14±10.13 mm Hg,P=0.001),IABP与PACD比较差异有统计学意义(P=0.010);而LVEDP较辅助前无明显降低(7.43±2.54 mm Hg vs.7.32±2.14 mm Hg,P=0.498;7.43±2.54 mm Hg vs.6.53±1.91 mm Hg,P=0.821),IABP与PACD比较差异无统计学意义(P=0.651);冠状窦血流量(CSF)较辅助前不明显或明显增加(86.63±7.71 ml/min vs.87.04±6.53 ml/min,P=0.981;86.63±7.71 ml/min vs.110.52±11.03 ml/min,P=0.000),IABP与PACD比较差异有统计学意义(P=0.000);IABP辅助后,左侧颈动脉流量(LCAF)较辅助前无明显降低(131.07±21.26 ml/min vs.128.36±20.38 ml/min,P=0.689),而PACD辅助后较辅助前增加(131.07±21.26 ml/min vs.151.29±18.37 ml/min,P=0.008),IABP与PACD比较差异有统计学意义(P=0.002)。PACD后血囊、人工血管内及动物心脏、肝、肾、肺等器官未见血栓、栓塞和缺血坏死;病理切片在光学显微镜下观察未见明显异常。结论 IABP对羊重度急性心力衰竭无辅助作用,而PACD辅助明显提高了MADP,增加了冠状窦血流量,改善了脑灌注流量,对重度心力衰竭具有良好的循环辅助效果。
Objective To compare the adjuvant effects of new paraaortic counterpulsation device (PACD) and intra-aortic balloon pump (IABP) on severe acute heart failure in sheep. Methods Eight small-tailed Han sheep were selected. The flap-free artificial blood vessels of homemade PACD (stroke volume 55 ml) were anastomosed to the descending aorta and the IABP was implanted into the descending aorta (stroke volume 40 ml) Bo assist. Ligation of coronary artery branches to establish animal models of severe acute heart failure, observed PACD and IABP-assisted hemodynamic changes after adjunct to severe acute heart failure; observed PACD-assisted and the main organs of sheep after the experiment. Results Eight heart failure models were successfully established. The cardiac output (CO), pulmonary capillary wedge pressure (PCWP), mean arterial pressure (MAP) and left ventricular end-diastolic pressure (LVEDP) The difference was statistically significant (t = -8.466,34.083,25.767, -5.219, P = 0.000). The mean arterial diastolic blood pressure (MADP) was significantly lower (P <0.05) with the aid of IABP and PACD than those without (38.34 ± 7.13 mm Hg vs.38.42 ± 6.81 mm Hg, P = 0.418; 38.34 ± 7.13 mmHg vs.54.14 ± 10.13 mm Hg, P = 0.001). The difference between IABP and PACD was statistically significant (P = 0.010), while LVEDP was not significantly lower than before (7.43 ± 2.54 mm Hg vs.7.32 ± 2.14 mm Hg, P = 0.498; 7.43 ± 2.54 mm Hg vs.6.53 ± 1.91 mm Hg, P = 0.821). There was no significant difference between IABP and PACD (P = 0.651). The coronary sinus blood flow (CSF) was not significantly or significantly increased P = 0.0001). The difference between IABP and PACD was statistically significant (P = 0.0007), P = 0.981; 86.63 ± 7.71 ml / min vs.110.52 ± 11.03 ml / min, P = ; After IABP assisted, left carotid artery flow (LCAF) was not significantly lower than before (131.07 ± 21.26 ml / min vs.128.36 ± 20.38 ml / min, P = 0.689) ± 21.26 ml / min vs.151.29 ± 18.37 ml / min, P = 0.008). The difference between IABP and PACD was statistically significant (P = 0.002). After PACD, there was no thrombus, embolism and necrosis in blood sac, artificial blood vessel and animal heart, liver, kidney, lung and other organs. No obvious abnormality was observed under optical microscope. Conclusions IABP has no auxiliary effect on sheep with severe acute heart failure. However, PACD-assisted MADP can obviously increase MADP, increase coronary blood flow, improve cerebral perfusion flow, and have good circulatory aids for severe heart failure.